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Total body irradiation + fludarabine compared to busulfan + fludarabine as “reduced-toxicity conditioning” for patients with acute myeloid leukemia treated with allogeneic hematopoietic cell transplantation in first complete remission: a study by the Acute Leukemia Working Party of the EBMT

Lookup NU author(s): Professor Matthew Collin

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Abstract

© 2020, The Author(s), under exclusive licence to Springer Nature Limited. The optimal conditioning for patients with acute myeloid leukemia in first complete remission treated with allogeneic hematopoietic cell transplantation (allo-HCT) has not been defined so far. In this retrospective study, we compared two “reduced-toxicity” regimens: intravenous busulfan at a total dose of 9.6 mg/kg (3 days) + fludarabine (Bu3/Flu) and total body irradiation at a dose of 8 Gy + fludarabine (TBI8Gy/Flu). In the entire study cohort (n = 518), the probabilities of overall survival (OS), leukemia-free survival (LFS), relapse and non-relapse mortality (NRM) at 2 years for Bu3/Flu and TBI8Gy/Flu were 62% vs. 72.5% (p = 0.051), 59.5% vs. 65% (p = 0.15), 30% vs. 20% (p = 0.01), and 10% vs. 14% (p = 0.18), respectively. In multivariate model for patients <50 years old, TBI8Gy/Flu was associated with improved LFS (hazard ratio (HR) = 0.5, p = 0.04), OS (HR = 0.31, p = 0.004), and survival free from both graft-versus-host disease and relapse (HR = 0.55, p = 0.03), as well as tendency to reduced risk of relapse (HR = 0.53, p = 0.08). Among patients aged 50 years or older the use of TBI8Gy/Flu was associated with increased incidence of NRM (HR = 3.9, p = 0.0009), with no significant impact on other outcome measures. We conclude that the use of TBI8Gy/Flu as “reduced-toxicity” regimen may be advised in younger patients with AML referred for allo-HCT.


Publication metadata

Author(s): Giebel S, Labopin M, Sobczyk-Kruszelnicka M, Stelljes M, Byrne JL, Fegueux N, Beelen DW, Rovira M, Spyridonidis A, Blaise D, Bornhauser M, Karadogan I, Savani BN, Nagler A, Mohty M, Martin S, Chevallier P, Neubauer A, Damaj G, Koc Y, Ganser A, Collin M, Yakoub-Agha I, Ozdogu H, Araujo MC, Itala-Remes M, Orchard K, Isaksson C, Bethge W, Martin H, Aljurf M, Faber E, Caballero D, Zak P, Leleu X, Bay J-O, Rohrlich P-S, Kroger N, Huynh A, Schafer-Eckart K, Milpied N, Lenhoff S, Ho A, Lopez JLB, Mordini N, Lioure B, Halaburda K, Olivieri A, Gedde-Dahl T, Protheroe R, Tischer J, Klammer M, Clausen J, Potter V, Ladetto M, Tilly H, Deconinck E, Brecht A, Muller LP, Heinicke T, Carrete JPT, Bazarbachi A, Remenyi P, Rubio MT, Fanin R, Perez-Simon JA, Niels M, Diez-Martin JL, Arat M, Hermine O, Socie G, Cornelissen JJ, Santarone S, Guyotat D, Bulabois CE, Bernasconi P, Johansson J-E, Vrhovac R, Greinix H, Lorenzo JLL, Apte S, Craddock C, Kobbe G, Zahrani MA, Dreger P, Lange A, Tbakhi A, Meijer E, Llamas CV, Santasusana JMR, Corradini P, Benedetti F, Rambaldi A, Gandemer V, Malfuson J-V, Kaare A, Risitano A, Petrini M, Selleri C, Wu D

Publication type: Article

Publication status: Published

Journal: Bone Marrow Transplantation

Year: 2021

Volume: 56

Pages: 481-491

Print publication date: 01/02/2021

Online publication date: 05/09/2020

Acceptance date: 25/08/2020

ISSN (print): 0268-3369

ISSN (electronic): 1476-5365

Publisher: Springer Nature

URL: https://doi.org/10.1038/s41409-020-01050-7

DOI: 10.1038/s41409-020-01050-7


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